Discrepancy between Intravascular Ultrasound and Coronary Pressure Measurement Criteria to Assess Optimal Implantation of Sirolimus-Eluting Stent.

초록

Background: Determination of pressure-derived myocardial fractional flow reserve (FFR) has been proposed as a means to assess stent deployment. However, data comparing morphologic and functional criteria of optimal stent deployment are still limited, especially in drug-eluting stent era. We investigated the relative value of FFR by comparing it with the validated intravascular ultrasound (IVUS) criteria for evaluating optimal sirolimus-eluting stent (SES) implantation. Methods: In 56 patients, an SES was implanted in 61 coronary lesions followed by optional adjuvant dilatation with noncompliant high-pressure balloon. IVUS assessment and FFR measurement were performed before and after the interventional procedure. Results: Receiver operator characteristic analysis defined a optimal FFR cut point at 0.94 for the prediction of optimal stent deployment based on validated IVUS criteria (final minimal lumen area [MLA] 5.5 mm2); at this threshold, the sensitivity, specificity, and predictive accuracy of FFR were 50%, 79%, and 64%, respectively. Both optimal IVUS and FFR results were achieved in 21 lesions (group A), but 21 lesions had optimal IVUS and suboptimal FFR results (group B). Plaque burden, reference lumen area, and final MLA were not different between groups. Length of stented segments was longer (49 vs 35 mm, p 0.019) in group B than group A. Conclusion: An FFR 0.94, measured after SES deployment, predicts an optimal result. However, an FFR 0.94 does not reliably predict an suboptimal stent result. In patients treated with multiple long SES implantation, FFR may underestimate the stent result compared with IVUS.